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NBCRNA and Our Duty as a Profession

Fellow AANA members,

I am working on a paper to present to you that outlines my concerns, beliefs, and positions with regard to the NBCRNA CPC issue. As I am doing my research, I have just come across some documents that have radically changed my view of the situation - so much so that I feel compelled to share them widely among the members. Let me give you the URLs for the documents so that you can download them and review them yourselves.

The first is the American Board Of Nursing Specialties Accreditation (ABSNC) Standards and are referenced below.

The second is the Institute for Credentialing Excellence (ICE) Standards, available at

Let me say that I was provoked into accessing these documents by an email conversation between Jay Horowitz and President Malina, which Jay has shared here on the listservs. In her reply to Jay, Pres. Malina says:

“NOTHING can force the NBCRNA to adopt AANA criteria, or share information with them.”

Given the Standards set by the ABSNC and quoted below, this is a mistaken - and deadly mistaken- notion. If you read them, you will see that there is indeed SOMETHING that can force the NBCRNA to collaborate with the AANA - the ABSNC.

If it can be demonstrated that the with the NBCRNA did not collaborate with the AANA, they risk their certification by the ABSNC. The Standards _demand_ a collaborative relationship between the NBCRNA and the “specialty organization” representing the profession - and that’s us. (Standard 3, below)

Here is the key notion that came to me as I reviewed these Standards: We, _the_profession_, not the NBCRNA or the COA, determine what constitutes the scope and standards of the profession. The purpose of the NBCRNA is simply to measure the competency of certificants in measuring up to the standards set by US - by the AANA. (See under “Definition and Scope - Criteria” below).

Similarly, the purpose of the COA is to make sure that schools appropriately educate, given our scope and standards, those who aspire to our profession.

We have placed the cart before the horse, and we are all too readily abdicating our responsibility. Without the AANA acting to set the scope and standards of the profession, there is no need for the NBCRNA or the COA. If we allow our Board to remain silent and not demand the collaborative relationship that must exist between the AANA and the NBCRNA, then we have failed as a professional organization. We do not need to threaten or cajole- we must simply ask the NBCRNA to meet the Standards set by the ABSNC and the ICE.

So - Jay was absolutely correct in his message. Just as our Bylaws dictate, the AANA has a duty to present, in a collaborative manner, its ideas, concerns, suggestions, and plans for recertification of CRNAs to the NBCRNA - and the NBCRNA has a duty to consider them, or risk losing our support and certification by the ABSNC.

We must put an end the notion that we can give away our involvement in the certification of the nurse anesthesia profession. Given our numbers, more than any other specialty nursing organization, the AANA stands for CRNAs.
It is simply impossible to think that the President, given her duty to support and honor the Bylaws of our Association, would deem it proper for the NBCRNA to go into deliberations on the future of recertification of CRNAs without official input from the AANA. However, if that is her belief, then it is her duty to place that idea as a motion in front of the Board for approval. I want to see who votes in support of it. It cannot be allowed to occur by default.

I once again call upon our Board, before it is too late, to _officially_ communicate, via a carefully considered paper developed with the assistance of the Continuing Education Committee and appropriate staff its concerns, ideas, and suggestions for improvement of the proposed CPC. Then place that document on the website so we can all see it. This is not how it is supposed to happen, as all of this should have been communicated _before_ the initial proposal was presented, but it is the best we can do.

Then, let us carefully debrief how we got into this mess, and use the principles of Quality Improvement to make sure we do not get here again.

Below are my selected quotes from the ABSNC Standards available at

================
DEFINITION AND SCOPE OF NURSING SPECIALTY
The certification examination program is based on a distinct and well-defined field of nursing practice that subscribes to the overall purpose and functions of nursing. The nursing specialty is distinct from other nursing specialties and is national in scope.
…
To be recognized, a professional specialty, like a profession, must have a distinct and developing body or system of scientific knowledge….The system of knowledge should reflect the profession’s view of the specialty, its realm and object, and the specified area of study.
…
CRITERIA
• A national or international organization with registered nurse members, advanced practice nurse members and/or APRN members that endorse or support the specialty. (My note: this is a direct reference to the AANA)

• The specialty has been defined, its core knowledge explicated, a scope of practice written, with the nursing component delineated, and standards for the specialty specified. (My note: notice that all of these things are assumed to have taken place outside of the certifying body’s purview)

DOCUMENTATION – The candidate (the “candidate” is the NBCRNA) must:
1.3 Provide written materials that document the national …organization(s) that endorse or support the specialty as defined in the scope and standards (e.g. membership brochure, position papers, web page(s)).

STANDARD 3
ORGANIZATIONAL AUTONOMY
The certifying organization (certifying governing body) is an entity with organizational autonomy governed in part or in whole by certified nursing members. However, a collaborative relationship exists between the certifying organization and a national or international specialty association that supports the nursing specialty and the standards for specialty practice.

RATIONALE
Certification is a mechanism for acknowledging and promoting professional competence. It also emphasizes commitment to consumer protection. A collaborative relationship should exist between the certifying organization (certifying governing body) and a specialty association that supports the specialty and sets standards for specialty practice.

CRITERIA
All policy and budgetary decisions relating to certification are the sole decision of the certifying organization (governing body), not subject to approval by any other entity. There is philosophical support from, and appropriate collaboration with, a national or international specialty association.
…
3.7 Submit a minimum of one letter/statement of agreement, endorsement, or support for the certifying organization by a national or international specialty organization with nursing members (e.g. letters of support, written agreements, position statements, newsletters, press releases, or journal articles).